| NPI | 1225077258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4022) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 5448) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2015-03-20 |